Case Manager VA
A registered nurse case manager who coordinates care for your patients or members remotely: assessments, care plans, utilisation review support, discharge follow-up and liaison with providers and payers. Patients get joined-up care and avoidable admissions and costs fall.
- Top 1% vetted talent
- No lock-in contracts
- Replacement guarantee
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Hourly rates · No lock-in contracts
Description
A Case Manager VA coordinates patient or member care remotely through assessments, care plans, discharge follow-up and liaison with providers and payers. The role is designed for registered nurses with case management or care coordination experience and operates within the client's clinical governance. Outsource Teams provides top 1% vetted talent, no lock-in contracts and a replacement guarantee, with clinical matters requiring local licensure escalated appropriately.
Responsibilities
- Complete telephonic assessments for assigned patients or members and develop care plans with measurable goals in the care management platform.
- Coordinate services across primary care, specialists, home health, pharmacy and community resources, and remove barriers to care.
- Support utilisation review by gathering clinical information, applying InterQual or MCG criteria and preparing cases for the client's medical director.
- Follow up patients after discharge to confirm medication reconciliation, appointments and understanding of the care plan.
- Monitor high-risk patients through regular check-ins and escalate deterioration or non-adherence to the treating clinician.
- Coordinate prior authorisations, appeals and benefit questions with payers on the patient's behalf.
- Document all assessments, interventions and contacts to the client's standards and within required timeframes.
- Report caseload outcomes such as readmissions, ED visits and care-gap closure to the case management lead.
- Work within the client's clinical governance, escalating anything that requires a clinician licensed in the client's jurisdiction.
- Maintain HIPAA and patient-privacy compliance in every contact and record.
Software & Tools
Requirements
- Registered nurse with at least 5 years of clinical experience, including 2 or more years in case management, care coordination, utilisation review or discharge planning.
- CCM, ACM or CMCN certification is preferred.
- Experience with care management platforms and EHRs such as Epic, Cerner, Salesforce Health Cloud, ZeOmega Jiva or TruCare, and with InterQual or MCG criteria.
- Knowledge of US payer processes including prior authorisation, appeals and Medicare and Medicaid programmes, or the equivalent for the client's market.
- Compassionate, clear spoken English for patient calls and precise written documentation.
- Strong organisation across a caseload of 60 or more patients with strict contact timeframes.
- HIPAA training completed.
- Reliable high-speed internet and backup power at a private workspace, working the client's business hours.
Frequently Asked Questions
What can they coordinate?
They can coordinate primary care, specialist services, home health, pharmacy, community resources and follow-up after discharge.
Can they support utilisation review?
Yes. They can gather clinical information and apply criteria such as InterQual or MCG before preparing cases for the client's medical director.
What systems can they use?
They can work with Epic, Cerner, Salesforce Health Cloud, Microsoft 365 and Microsoft Excel.
How experienced are the candidates?
Candidates are expected to be registered nurses with at least five years of clinical experience, including case management, care coordination, utilisation review or discharge planning experience.
How much does it cost?
Rates are listed in USD at $5 per hour for entry-level talent, $7 per hour for intermediate and $9 per hour for senior talent. Both full-time and part-time options are available.
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